Impact of Mean Blood Pressure Profiles in Percutaneous Left Ventricular Assist Device-Supported High-Risk Percutaneous Coronary Intervention: The PROTECT III Study.
Academic Article
Overview
abstract
BACKGROUND: Percutaneous left ventricular assist devices are used prophylactically to prevent hypotension during high-risk percutaneous coronary intervention. However, the impact of preprocedural hemodynamic profiles on procedural and clinical outcomes in these patients is unknown. METHODS AND RESULTS: Patients from the central venous access device PROTECT III registry (NCT04136392) were categorized according to preprocedural mean blood pressure (MBP). Procedural and in-hospital outcomes, including hypotensive episodes, need for prolonged percutaneous left ventricular assist device support, and in-hospital death, were compared between groups. We also assessed the relationship between preprocedural MBP and 90-day major adverse cardiovascular and cerebrovascular events, which included all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization, as well as with 1-year mortality. A total of 1159 patients underwent percutaneous left ventricular assist device-supported high-risk percutaneous coronary intervention and were stratified into 4 hemodynamic profiles of preprocedural MBP level: MBP>100 mm Hg (n=242), >90 to ≤100 mm Hg (n=264), >80 to ≤90 mm Hg (n=306), and ≤80 mm Hg (n=347). Lower preprocedural MBP was associated with baseline anemia, history of heart failure, left main disease, and transfer from another hospital. In-hospital and procedural adverse outcomes did not differ between the BP categories. However, 90-day major adverse cardiovascular and cerebrovascular events rates and 1-year mortality increased with decreasing baseline BP levels. The association between BP category and 1-year mortality remained significant after adjustment for other factors (hazard ratio [HR], 0.79 [95% CI, 0.71-0.88], P<0.001). CONCLUSIONS: In a real-world cohort undergoing high-risk percutaneous coronary intervention with percutaneous left ventricular assist device support, there was no association between hemodynamic status and in-hospital outcomes. Lower preprocedural BP was associated with higher rates of 90-day major adverse cardiovascular and cerebrovascular events and 1-year mortality. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04136392.
